HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Freeman, R. K. Articles by Wozniak, T. C. Search for Related Content PubMed PubMed Citation Articles by Freeman, R. K. Articles by Wozniak, T. C. Related Collections Related Article

J Thorac Cardiovasc Surg 2007;133:333-338
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

Postoperative esophageal leak management with the Polyflex esophageal stent

^a Department of Thoracic and Cardiovascular Surgery, St Vincent Hospital, Indianapolis, Ind
^b Department of Thoracic and Cardiovascular Surgery, Methodist Hospital, Indianapolis, Ind.

Read at the Eighty-sixth Annual Meeting of The American Association for Thoracic Surgery, Philadelphia, Pa, April 29–May 3, 2006.

Received for publication April 25, 2006; revisions received September 26, 2006; accepted for publication October 9, 2006.

^_* Address for reprints: Richard K. Freeman, MD, 8433 Harcourt Rd, Indianapolis, IN 46260. (Email: RFreeman{at}corvascmds.com).

OBJECTIVE: Leak after esophageal anastomosis or perforation repair prolongs hospitalization, prevents oral hydration and nutrition, and can produce localized infection or sepsis. This investigation reviews our experience treating postoperative esophageal leaks with the Polyflex esophageal stent (Boston Scientific, Natick, Mass).

METHODS: Over a 30-month period, patients with a postoperative esophageal leak were treated with the Polyflex stent for leak occlusion. Leak occlusion was confirmed by means of esophagraphy. Patients were followed until their stent was removed and their esophageal leak had resolved.

RESULTS: Twenty-one patients had 27 stents placed for leak occlusion after esophagectomy (n = 5), esophageal perforation (n = 5), surgical (n = 4) or endoscopic (n = 2) antireflux procedure, and esophageal diverticulectomy (n = 3) or myotomy (n = 2). The mean interval between surgical intervention and stent placement was 12 ± 8 days (range, 3–31 days). Occlusion of the leak occurred in 20 patients. One patient experienced a dehiscence of the surgical esophageal perforation repair requiring esophageal diversion. Stent migration requiring repositioning (n = 3) or replacement (n = 4) occurred in 5 (24%) patients. Twenty (95%) stents were removed without residual leak (mean, 51 ± 43 days; range, 15–175 days). One patient had a stricture after stent removal that required endoscopic dilatation. One patient in this series died.

CONCLUSIONS: The Polyflex esophageal stent is an effective method for occluding a postoperative esophageal leak. It rapidly eliminates contamination of the mediastinum, pleura, and peritoneum; allows oral hydration and nutrition; and is easily removable. These stents also offer an appealing alternative to traditional esophageal diversion and subsequent reconstruction in patients with a persistent esophageal leak.

This article has been cited by other articles:

				C. Zisis, A. Guillin, L. Heyries, P. Lienne, X.-B. D'Journo, C. Doddoli, R. Giudicelli, and P.-A. Thomas Stent placement in the management of oesophageal leaks Eur. J. Cardiothorac. Surg., March 1, 2008; 33(3): 451 - 456. [Abstract] [Full Text] [PDF]

				R. K. Freeman, J. M. Van Woerkom, and A. J. Ascioti Esophageal Stent Placement for the Treatment of Iatrogenic Intrathoracic Esophageal Perforation Ann. Thorac. Surg., June 1, 2007; 83(6): 2003 - 2008. [Abstract] [Full Text] [PDF]